Decreasing trend of monkeypox cases in Europe and America shows hope for the world: Evidence from the latest epidemiological data

Monkeypox (MPOX) is a zoonotic viral disease caused by an Orthopox DNA virus named mpox virus (MPOXV). Scientists first discovered MPOXV in a monkey transported from Singapore to Denmark for research purposes. However, at first, the virus's primary animal reservoir was rodents. In 1970, a 9‐year‐old child from the Democratic Republic of the Congo was first diagnosed with MPOX. Since then, 11 African nations have recorded human instances of MPOX. Between 1970 and 1979, six African countries reported only 48 confirmed human MPOX cases. However, African nations reported more than 400 human MPOX cases at a death rate close to 10% by 1986. Several minor MPOX outbreaks between 1991 and 1999 reported 500 MPOX cases in tropical Central and Western Africa. However, isolated cases have been discovered in countries outside of Africa since 2003. The United States of America (USA) had the first outbreak of MPOX outside of Africa in 2003. The multicountry MPOX outbreaks have been reported in nonendemic nations starting in early May 2022. Belgium, Sweden, and Italy detected their first confirmed MPOX cases on May 19, 2022. Australia reported the first case on May 20, 2022, in Sydney and Melbourne in persons who had visited Europe just before their detection. On May 20, 2022, France, Germany, and the Netherlands reported their first cases. In contrast, the United Arab Emirates announced the finding of its first case in late May 2022. Spain reported its first two deaths in July 2022, and Belgium reported its first death in August 2022 due to MPOX disease. On July 23, 2022, the World Health Organization (WHO) declared MPOX a Global Public Health Emergency. Even though the MPOX disease has a low fatality rate ranging from 3% to 6%, the recent outbreak, and its epidemiological data have created concern among the general population worldwide. MPOX signs and lesions can be hard to tell apart from smallpox in their clinical presentation. Backache, headache, chills, fever, weariness, myalgia, lethargy, and swollen lymph nodes are some of the nonspecific symptoms of MPOX disease that first appear. Three days later, the fever goes down and the rash begins to centrifugally cover the body. Similar to the smallpox rash, it begins as macules for 2–4 weeks before changing into papules, vesicles, pustules, and lastly crusts and scabs. With sizes ranging from 0.5 to 1 cm, the numbers can approach the thousands. They originate from the trunk and disperse throughout the body in a centrifugal pattern. MPOX can be distinguished from other infections diseases by the severe lymph node enlargement that is seen in the neck, axillary, and groin areas. There may also be pharyngeal, conjunctival, and vaginal mucosal inflammation. Numerous issues have been documented, including secondary bacterial infections, respiratory issues, bronchopneumonia, encephalitis, corneal infections with subsequent vision loss, gastrointestinal issues, vomiting, and diarrhea with dehydration. MPOX continues to primarily affect young men who have sex with men (MSM), between 18 and 50 years (87%). The overall risk of MPOX infection is estimated as moderate for MSM and low for the general population based on data from the present outbreak. However, the smallpox vaccine showed protection in 85 cases out of 100 cases of MPOX. MPOX‐related hospitalization remains rare; studies indicate that the proportions range from 5% to 10%. Hospitalization may be necessary for patients who experience complications from MPOX, with the most frequent causes being severe anorectal and genital pain that needs analgesia, bacterial superinfection (cellulitis) affecting the genital and perineal region, urinary retention due to penile edema, or ocular involvement. A severe or complicated MPOX infection, such as the emergence of a more extensive rash, may affect patients who are pregnant, children, or those who are immunocompromised, such as those with advanced or untreated HIV.

reported its first two deaths in July 2022, and Belgium reported its first death in August 2022 due to MPOX disease. 5 On July 23, 2022, the World Health Organization (WHO) declared MPOX a Global Public Health Emergency. 6 Even though the MPOX disease has a low fatality rate ranging from 3% to 6%, the recent outbreak, and its epidemiological data have created concern among the general population worldwide. MPOX signs and lesions can be hard to tell apart from smallpox in their clinical presentation. 7 Backache, headache, chills, fever, weariness, myalgia, lethargy, and swollen lymph nodes are some of the nonspecific symptoms of MPOX disease that first appear. Three days later, the fever goes down and the rash begins to centrifugally cover the body. Similar to the smallpox rash, it begins as macules for 2-4 weeks before changing into papules, vesicles, pustules, and lastly crusts and scabs. 7 With sizes ranging from 0.5 to 1 cm, the numbers can approach the thousands. 7 They originate from the trunk and disperse throughout the body in a centrifugal pattern. MPOX can be distinguished from other infections diseases by the severe lymph node enlargement that is seen in the neck, axillary, and groin areas. 7 There may also be pharyngeal, conjunctival, and vaginal mucosal inflammation.
Numerous issues have been documented, including secondary bacterial infections, respiratory issues, bronchopneumonia, encephalitis, corneal infections with subsequent vision loss, gastrointestinal issues, vomiting, and diarrhea with dehydration. 8 MPOX continues to primarily affect young men who have sex with men (MSM), between 18 and 50 years (87%). The overall risk of MPOX infection is estimated as moderate for MSM and low for the general population based on data from the present outbreak. 9 However, the smallpox vaccine showed protection in 85 cases out of 100 cases of MPOX. 10 MPOX-related hospitalization remains rare; studies indicate that the proportions range from 5% to 10%. 11 Hospitalization may be necessary for patients who experience complications from MPOX, with the most frequent causes being severe anorectal and genital pain that needs analgesia, bacterial superinfection (cellulitis) affecting the genital and perineal region, urinary retention due to penile edema, or ocular involvement. A severe or complicated MPOX infection, such as the emergence of a more extensive rash, may affect patients who are pregnant, children, or those who are immunocompromised, such as those with advanced or untreated HIV. 11

| THE PRESENT SITUATION OF THE MPOX OUTBREAK
The majority of cases reported in the recent multicountry outbreak were reported from the Region of the Americas (66.9%) and the European Region (31.4%). 12 Most MPOX cases recorded in Europe and America were individuals who were identified through primary care and sexual health services, but who had no prior history of travel days after the date of exposure, vaccination may lessen disease symptoms but will not prevent the illness. 20 Due to the limited availability of vaccines, primary preventive vaccination (PPV) and postexposure preventive vaccination strategies may be used to specifically target those who are at a greater risk of exposure and close contact with cases. 9 PPV initiatives should pay special attention to gay, bisexual, or other males or transgender people who have sex with men who are more likely to be exposed, as well as people who are at risk of exposure at work, based on epidemiological or behavioral criteria. 9 Health promotion programs and community involvement are also essential to ensuring effective outreach and high vaccine acceptance and uptake among those most at risk of exposure. 9 Immune globulin is another option for prophylaxis for patients with severe immunosuppression in addition to the smallpox vaccine, albeit its advantages are still unknown. 20  Md. Rabiul Islam: conceptualization; writing-review & editing.

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.

TRANSPARENCY STATEMENT
The lead author Md. Rabiul Islam affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.